GLENDA ELIZABETH JACKSON R.N.
NPI 1205291572
Nurse Practitioner - Psychiatric/Mental Health in Kenosha, WI

Q: What is Glenda Jackson's NPI number?

The NPI number for Glenda Jackson is 1205291572. It was assigned to this individual provider in the NPPES registry on December 30, 2015.

Q: What is Glenda Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Glenda Jackson was last updated on June 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 30, 2015PECOS EnrolledAccepts Medicare Assignment

12225 71ST ST, KENOSHA, WI 53142(877) 666-7223(262) 948-4871 Get Directions Write a Review

NPPES record last updated: June 25, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 25, 2025, Feb 7, 2025, Dec 30, 2015 (3 updates tracked since 2015).

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About Glenda Elizabeth Jackson R.n. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GLENDA ELIZABETH JACKSON R.N. (NPI 1205291572) is an individual psychiatric/mental health provider in Kenosha, Wisconsin, licensed in Wisconsin (16452-33) and active in the NPI registry since December 2015. She is enrolled in Medicare PECOS, maintains a secondary practice location in Milwaukee, and is a graduate of Other (2024).

NPPES Registry Identity

NPI1205291572

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameGLENDA ELIZABETH JACKSONCredential: R.N.

Location Address12225 71ST STKenosha, WI 53142-7320

Mailing AddressPo Box 735044Chicago, IL 60673-5044 · (800) 326-2250

Phone(877) 666-7223

Fax(262) 948-4871

Sole ProprietorYes

Medical School CMSOtherGraduated 2024

Enumeration DateDecember 30, 2015

Last NPPES UpdateJune 25, 20253 updates tracked since enumeration

NPPES CertifiedJune 25, 2025

✔ NPI 1205291572 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in WI · 16452-33

Also ListedNurse PractitionerTaxonomy 363L00000X · License 16452 (WI)

12225 71ST ST, Kenosha, WI 53142

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Secondary Practice Location 1

Location 14126 N 16th StMilwaukee, WI 53209-6915 · Phone (414) 544-2882

Other Identifiers 2

Medicaid100310731WI

Medicaid100310882WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Aspirus Health Plan, CareSource (Common Ground Healthcare) and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Glenda Elizabeth Jackson R.n. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9537682265

PECOS Enrollment IDI20250402003137

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 53142 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$82.92 typical visit price

range $53.90 – $163.24

Typical copayment $20.73 (range $13.47 – $40.81)

Most-billed visit code 99203

Established Patient

$95.41 typical visit price

range $17.40 – $133.76

Typical copayment $23.85 (range $4.35 – $33.44)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. ADAM M STOLL MSW, APSW

Social Worker (Clinical)